NR 508 Week 7 Grand Round
You will be required to respond to at least three other students, who have no responses to their posting.** In your post, you
... [Show More] will discuss a drug that could be prescribed for the condition DIFFERENT than those presented. Come up with a different treatment plan from the Walmart or Target $4 RX list, and offer reasons for the change or if the drug is not on the list, why? Use references to support your responses. You should also answer the presenter’s five questions.
Hi,
Thank you for your informative presentation on ADHD! You gave a very thorough summary of the most commonly prescribed medications for children with ADHD. As we have learned, ADHD medications are prescribed to improve attention and reduce hyperactivity and impulsivity in children. They may also be used to improve ability to focus, work and learn. In addition, they may be used to reduce aggression, provide a calming effect and improve coping with frustration. While stimulants are generally the first line of treatment for ADHD, selective serotonin reuptake inhibitor (SSRIs) can be alternate treatment plans. SSRIs can also be used in combination with stimulants. According to Kim & Boylan (2016), SSRIs have been shown to be effective in reducing ADHD-related symptoms in children. Anxious children have trouble paying attention. Therefore, selection of an ADHD medication depends on the patient’s specific factors, as well as drug side effects, interactions and existing conditions. Fluoxetine, or Prozac, can be prescribed to improve mood swings and alleviate anxiety. For pediatric dosing, fluoxetine is prescribed at the starting dose of 10 mg PO daily (Woo & Robinson, 2016). After one week, medication can be titrated to 20 mg per day. It is important to discuss with the healthcare provider if there are any potential drug interactions. Fluoxetine 10 mg tablets are available on the Walmart $4 RX list (Walmart RX Program, 2018).
This is an important finding since promotional pricing of medications have an impact on the number of prescriptions filled in large retail companies. One of the biggest contributor to medication nonadherence is financial burden. According to Joslin, Wojcik, Fisher, & Grant (2014), the cost of prescription medications deter patients from properly taking their medication. In order to attract new consumers, large retail companies such as Target, CVS, and Walmart have instituted low cost generic prescription programs. From a business standpoint, these companies constitute a sizable portion of the pharmaceutical dispensing market (Joslin et al., 2014). By lowering cost of generic prescriptions, their hope is to attract new consumers to move other regularly prescribed medications to their pharmacy as well. Sometimes these particular programs have the potential to sway prescribing habits because prescribers may change medications based on whether they are available in the prescription program. This is beneficial in terms of increasing medication nonadherence for the patients and improving overall business for the large retail companies. Great work this week!
Answers to the quiz:
1. False
2. B
3. False
4. C
5. B
References
Joslin, J., Wojcik, S.M., Fisher, A., & Grand, W.D. (2014). Do free or low-cost antibiotic promotions alter prescription filling habits? Pharmacy Practice, 12(3), 1-4.
Kim, S., & Boylan, K. (2016). Effectiveness of antidepressant medications for symptoms of irritability and disruptive behaviors in children and adolescents. Journal of Child & Adolescent Psychopharmacology, 26(8), 694-704.
Walmart RX Program. (2018). Guide to low cost prescriptions. Retrieved from https://i5.walmartimages.com/dfw/4ff9c6c9-e286/k2-_85e442c0-01c0-40e8-ae97-06162066b801.v1.pdf
Woo, T & Robinson, M. (2016). Pharmacotherapeutics for the advanced practice nurse prescribers. (4th ed.) Philadelphia, PA: F. A. Davis Company
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Hi Jessica,
Thank you for your informative presentation on GAS pharyngitis! You presented an array of medications prescribed for this particular condition. As you mentioned, narrow spectrum antibiotics such as penicillin V is the first choice treatment. It was difficult to find an alternate treatment since you presented all of the medications recommended for GAS pharyngitis. The only alternate treatment that I could find was erythromycin, which is often reserved for patients who are allergic to penicillin. The pediatric dosing for erythromycin base is 30 to 50 mg/kg/day four times a day (Woo & Robinson, 2016). According to Petersen, Phillips, Soukup, Komaroff, & Aronson (2013), erythromycin was associated with a more rapid resolution of sore throat symptoms, as well as lower incidence of cough. However, erythromycin has the potential to promote drug-resistant organisms so it should be reserved for those who truly benefit from it. When prescribing the appropriate medication, healthcare providers should consider effectiveness, spectrum of activity, safety, dosing schedule, cost, and compliance issues (Petersen et al., 2013).
Sometimes it is difficult for patients to complete an entire course of antibiotics. Therefore, they opt for the single intramuscular dose of penicillin G benzathine. At the same time, a premixed penicillin G benzathine/procaine injection (Bicillin C-R) is also a favorable option because it lessens the discomfort of the injection. Unfortunately, Bicillin C-R and erythromycin base are not available on the Walmart Rx $4 list. As I mentioned in a previous peer response, low cost generic prescription programs have been instituted by large retail companies to generate business and increase medication nonadherence. Certain categories such as antibiotics, prenatal vitamins, and other generic drugs are not large expenses to retail companies so they can risk that small investment to gain more consumers for future business (Joslin, Wojcik, Fisher, & Grant, 2014). However, prescription programs are unlikely to encompass every type of antibiotic. Bicillin C-R and erythromycin base are not commonly prescribed medications. Therefore, it is important for healthcare providers to keep that in mind when prescribing medications for patients with allergies and other complicated drug interactions. Great work this week!
Answers to the quiz:
1. B
2. False
3. A
4. C
5. A
References
Joslin, J., Wojcik, S.M., Fisher, A., & Grand, W.D. (2014). Do free or low-cost antibiotic promotions alter prescription filling habits? Pharmacy Practice, 12(3), 1-4.
Petersen, K., Phillips, R.S., Soukup, J., Komaroff, A.L., & Aronson, M. (2013). The effect of erythromycin on resolution of symptoms among adults with pharyngitis caused by Group A Streptococcus. Journal of General Internal Medicine, 12(2), 95-101.
Woo, T & Robinson, M. (2016). Pharmacotherapeutics for the advanced practice nurse prescribers. (4th ed.) Philadelphia, PA: F. A. Davis Company
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Hi Arleta,
Thank you for your presentation on hypothyroidism! You did a great job summarizing the treatment for hypothyroidism. As we have learned, the most commonly prescribed medication for hypothyroidism is levothyroxine. Levothyroxine is a man-made thyroid hormone used to replace the hormone that is normally produced by the thyroid gland (Woo & Robinson, 2016). In addition to levothyroxine, the generic drug of liothyronine can also be prescribed. The adult dosing for liothyronine is 25 mcg daily and can be titrated by 12.5 mg to 25 mcg per day every one to two weeks (Epocrates, 2016). Brand names of liothyronine include Cytomel and Triostat. Some common side effects of liothyronine include headache, nervousness, tremor, diaphoresis, and arrhythmia (Epocrates, 2016). As you had mentioned, it is important to emphasize regular follow-up examinations. When initiating treatment, TSH levels should be evaluated within four to six weeks. Routine TSH levels should be evaluated every six months. The same considerations are expected for liothyronine. Unfortunately, liothyronine is not listed in either Walmart or Target $4 list. Levothyroxine, which is the most commonly prescribed medication, is eligible in both Walmart and Target $4 prescription program (Walmart RX Program, 2018; Target Pharmacy, 2018). As I had mentioned in a previous peer response, low cost generic prescription programs have been instituted by large retail companies to generate business and increase medication nonadherence (Joslin, Wojcik, Fisher, & Grant, 2014). Since there is no cure for hypothyroidism, lifelong therapy for this condition is inevitable. Therefore, patients have a higher incidence of medication adherence if they are able to afford their medications. Nice work this week!
Answers to the quiz:
1. D
2. B
3. C
4. B
5. E
References
Epocrates. (2016). Liothyronine. Retrieved from https://online.epocrates.com/drugs/568/Cytomel
Joslin, J., Wojcik, S.M., Fisher, A., & Grand, W.D. (2014). Do free or low-cost antibiotic promotions alter prescription filling habits? Pharmacy Practice, 12(3), 1-4.
Target Pharmacy. (2018). Target Pharmacy $4 Program. Retrieved from https://www.hamline.edu/uploadedFiles/Hamline_WWW/SECTIONS/Offices_-_Student_Services/_Original_Section(3)/Documents/TargetGenericsProgramDrugList.pdf
Walmart RX Program. (2018). Guide to low cost prescriptions. Retrieved from https://i5.walmartimages.com/dfw/4ff9c6c9-e286/k2-_85e442c0-01c0-40e8-ae97-06162066b801.v1.pdf
Woo, T & Robinson, M. (2016). Pharmacotherapeutics for the advanced practice nurse prescribers. (4th ed.) Philadelphia, PA: F. A. Davis Company [Show Less]